Resume Rawat Jalan POLI IGD [PDF]

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RJ.04/RM/2020/REV1



PEMERINTAH KABUPATEN BELITUNG DINAS KESEHATAN UPT. RUMAH SAKIT UMUM DAERAH dr. H. MARSIDI JUDONO JL. JEND.SUDIRMAN KM 5, TANJUNG PANDAN, BELITUNG TELP / FAX : 0719-21071 / 22190



RESUME MEDIS IGD / RAWAT JALAN



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TANGGAL LAHIR : NOMOR RM



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E-KTP



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Tanggal Masuk /Jam: Riwayat Alergi : Keadaan Saat Pulang *: 1. perbaikan 2. Meninggal 3. Lain-lain:.............................................. Tindak Lanjut Lanjut Perawatan* : 1. Boleh Pulang 2. Menolak dirawat 3. Dirujuk Ke................................. *Lingkari Yang Sesuai Ringkasan riwayat penyakit: .......................................................................................................................................................................... .......................................................................................................................................................................... Pemeriksaan fisik saat datang: Keadaan umum: ................GCS:.........T:......... N:........R:.......S:........ skala nyeri :......... .......................................................................................................................................................................... .......................................................................................................................................................................... Status lokalisata:.............................................................................................................................................. Hasil pemeriksaan penunjang: Laboratorium::................................................................................................................................................... Radiologi :......................................................................................................................................................... Pemeriksaan Penunjang lain:........................................................................................................................... .......................................................................................................................................................................... Diagnosa: 1........................................................................................................ICD 9/10:....................... 2........................................................................................................ICD 9/10:....................... 3........................................................................................................ICD 9/10:....................... Terapi : .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... Tindakan: .......................................................................................................................................................................... Kontrol: ............................................................................................................................................................ Rencana tindak lanjut:...................................................................................................................................... Tempat/tanggal/jam : UPT. RSUD H.M. Judono, Belitung/............................/..............



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RJ.04/RM/2020/REV1